Social & Spatial Epidemiology Unit

Cluster member Sarah McKetta, working with Seth Prins, Jonathan Platt, Lisa Bates, and Katherine Keyes, recently published research examining social roles of US women and how the patterning of these roles impacts mortality.

Changes in employment patterns in the 20th century have led to the majority of US women participating in the labor force. However, as women enter the workforce and become laborers, their traditional domestic roles have not been supplanted; rather, the role of laborer is an additional social role to women who already frequently occupy the roles of parent and spouse. It turns out that having more social roles – parent, spouse, laborer – is associated with better health than having fewer. Yet, measurement of roles generally does not account for the dynamics of women’s lifecourses: women’s roles change throughout the lifecourse, and it may be that the timing, onset, and duration of these roles is as meaningful for health as the number or types of roles themselves.

These researchers partially replicated a study by Sabbath et al. using the Panel Study on Income Dynamics, a nationally-representative, longitudinal survey of households in the United States. The current study examined the social roles of women ages 18-50 every survey wave from 1968-2013; each participant’s pattern of social roles – composed of marriage status, labor status, and parent status – was compiled, and then using sequence analysis and hierarchical clustering these patterns were clustered so that women with similar lifecourse patterns were grouped together into categories.

They found 5 empirically-derived lifecourse types in this sample:

• Type 1, “Non-working, married, later-mothers” (N=2,340): These women were consistently married, had children later than other women (e.g., mid-to-late twenties compared to early twenties), and were unlikely to work during their reproductive years.
• Type 2, “Working, divorced mothers” (N=2,264): These women had a high probability of marriage early in life and to be unmarried later. They were more likely to work as they got older (e.g., after age 35). Nearly all had children.
• Type 3, “Working and non-working never-married mothers” (N=581): These women were much less likely to be married at any point in time than other women with children. They were about equally likely to be working as not during these years. Nearly all had children.
• Type 4, “Working, never-married non-mothers” (N=345): These women worked consistently, and were less likely than other women to marry or have children.
• Type 5, “Non-working, married, earlier-mothers” (N=767): These women were less likely to work, were consistently married, and had children earlier than the “Non-working, married later mothers.”

Interestingly, none of these lifecourse types was characterized by the “triple role” of laborer, parent, and spouse. However, the authors found that lifecourse types had differential mortality, with Type 1 (non-working, married, later-mothers) having the lowest age-standardized mortality rates. Adjusting for race, birth year, number of children, and educational attainment, Type 3 (working and non-working never-married mothers) and Type 4 women (working, never-married, non-mothers) had significantly higher mortality risks than Type 1 women (RR =1.57 and 1.81, respectively). These risks were somewhat attenuated with the addition of household income to the model, suggesting an incomplete mediating role of income, though the risks were persistently elevated in these groups.

Overall, the authors concluded that timing of childbearing did not significantly predicted poor health in this population, likely because no empirically-derived lifecourse type consistently occupied the “triple role” of laborer, partner, and parent in this sample. Delaying childbearing is thought to be beneficial for women because it allows for gains in the workforce; in this sample where few married mothers also worked, it made sense to not see protective effects of delaying childbearing. In addition, lifecourse type conferred an increased risk of mortality among women who did not have partners, regardless of parenting status, which is a common finding in social science research. Marriage is thought to provide social benefits and economies of scale, which are overall very beneficial for long-term health outcomes.

It may be that social roles impact health, or that women select into social roles because of preexisting health problems or disability. Because the women in the study were followed starting at age 18, these factors were not highly concerning to the authors. Overall, this study contributes to a large corpus of work examining how women’s social realities contribute to health disparities.

Below are a couple of key references for the sequence analysis methods used in the paper.

Gauthier, J., et al., Multichannel sequence analysis applied to social science data. Sociological Methodology, 2010. 40(1 ): p. 1 – 38.

Gabadinho, A., et al. Analyzing and Visualizing State Sequences in R with TraMineR. Journal of Statisitcal Software, 2011. 40(4): p. 1 – 37.